A 22-year-old female with 9 years history of type 1 diabetes mellitus on multi-dose insulin regime was admitted with right upper quadrant abdominal pain, nausea and occasional vomiting. Her diabetes control was historically poor and she had similar symptoms multiple times in the past. Physical examination revealed a body mass index of 22 kg/ m2, and tender liver enlargement. HbA1c was 90.2 mmol/mol (10.4%), cholesterol - 4 mmol/ L (154.7 mg/dL), triglycerides - 9 mmol/L (797 mg/dL), ALT - 210, alkaline phosphatase (ALP) - 160, GGT - 44 with normal bilirubin level.
The metabolic, auto-immune and viral liver screening tests were all normal. Patient did not consume any oral medications, illicit drugs or food supplements. Liver ultrasound revealed a coarse echo-texture without biliary abnormalities. Her diabetes treatment was modified and after 2 weeks in the diabetes clinic she was…
